At the end of the day last Wednesday, Obama aides and a handful of senators hashed out the details of a $787 billion spending package in Senate Majority Leader Harry Reid’s office.

Larry Summers, the architect of the plan, was no longer in the room, and even Rahm Emanuel — who was leading the White House team — sometimes stepped out for meetings. To Reid’s surprise, that left a familiar figure, Peter Orszag, the boyish, gangly director of Obama’s Office of Management and Budget in a position to shape the final compromise.

“Sen. Reid seemed particularly surprised that I was effective,” Orszag recalled during an interview in the Old Executive Office Building Tuesday. “He kept saying, like, ‘Aren’t you an academic?’”

"In my mind, if there is a hero in all of this, it is Peter Orszag,” Reid, who knew Orszag from his previous role as director of the Congressional Budget Office, observed, unprompted, to Politico’s David Rogers after the deal was done. “He was wonderful.”

Orszag’s emergence as a central figure and key negotiator in Obama’s economic policy team has come as a bit of a surprise to watchers of the administration, from Reid on down.

Orszag, at 40 the youngest member of the Obama Cabinet, left a profound mark on the stimulus, which focused heavily on healthcare technology, a major focus of his research. He and his deputy, Rob Nabors, brokered a key late deal on spending on school construction, a Democratic aide said.

And the bill spends more than $1 billion on Orszag’s pet cause, research on the effectiveness of medical practices, which he sees as an opening to reforming American health care through sheer analytical will.

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Now Orszag is preparing for the biggest week of his career, with a "fiscal responsibility" summit Monday and the release of Obama's first budget Thursday. He's signaling that the moves in the stimulus package are just a hint of what's to come in a budget that will begin in earnest the arduous process of health care reform.

“What has already been accomplished is a huge start toward a more efficient [health care] system, and I think you’re going to see more in the budget next week,” he told Politico.

Though the budget’s details have been closely held, Orszag revealed, in broad terms, two: a continued focus on health care policy and a plan “to restore the nation to a sustainable fiscal trajectory over the five-to-10- year window.”

The next step on health care, he said, is a set of “changes to Medicare and Medicaid to make them more efficient, and to start using those programs more intelligently to lead the whole health care system.”

With a growing body of research finding some practices more cost-effective than others, the program's reimbursement rules can be used to force changes at those hospitals — a sort of back door to health care reform.

“Medicare and Medicaid are big enough to change the way medicine is practiced,” he said.

The push to use changes to Medicare and Medicad reimbursement rates won’t come without a fight. Critics see the call for efficiency as easier said than done, and largely a smokescreen for simply saving money for cutting federal payments to doctors and hospitals.

“Some of it will look kind of reformish,” said James Capretta, an associate director of OMB in President George W. Bush’s first term, “but they’re going to go after the provider community in a big way.”

Orszag’s other key agenda item next week will be an effort to change the debate on Medicare and Social Security.

Orszag’s long-running project — something that has made him the left’s favorite Cabinet member — has been replacing talk of an “entitlement crisis” with his argument that Social Security requires only modest tax hikes and benefit cuts, while Medicare and Medicaid have much more dramatic fiscal woes.

“Social Security faces an actuarial deficit over the next 75-100 years. In the past, I’ve resisted the term ‘crisis’ to describe that kind of situation,” he said. “This is not quantitatively as important as getting health care done.”

Orszag’s broad early agenda has taken him well onto the turf of a planned “health czarm” who has yet to be named, but he wouldn’t directly answer a question on whether Obama still plans to fulfill his campaign pledge to cover America’s uninsured during his first term, something Orszag said he sees as “a goal.”

Orszag has already broadened his agenda, ranging from stimulus to health care reform, staking an early claim to a key administration role. And there are two models for the director of the Office of Management and Budget. In some administrations, he is simply the chief accountant, tasked with implementing policy designed across the way at the White House or one building over at the Treasury Department.

But in other administrations, the budget director has himself emerged as the key policy maker, like Reagan budget director David Stockman, who shaped the supply-side economics of Reagan’s first term, and George H.W. Bush’s budget director Richard Darman, a central figure in that administration.

“The OMB director has the potential — it depends on the administration or the person — to be one of the three or four most important people in the government,” said Robert Greenstein, the executive director of the Center on Budget and Policy Priorities, a think tank. “What last week made clear was that he is indeed one of the handful of most important people in the administration on a range of policies,” he said.

Former Federal Reserve Chairman Alan Greenspan also predicted that Orszag would consolidate his power internally.

“He is going to end up in a central role, because he is at a level that rarely is the case for OMB directors — and I’ve known and very large number of them,” said Alan Greenspan.

“I find him up at the top of the list of all those with respect to technical competency,” he said, adding that Orszag knows more about the health care system “than almost any other economist.”

With his large internal reach and his influence on health care policy, Orszag has so far been successful in escaping the government bean counter’s “green eye-shade box,” a phrase he used while contorting his long form into a vaguely boxlike shape.

Despite his credentials — a Ph.D. from London School of Economics, a stint in the Clinton White House, and top economic policy jobs since then — escaping that caricature still takes a bit of effort. Orszag is, not to put to fine a point on it, a bit of a geek. One of three mathematically inclined sons of a Yale University math professor, he has a tentative way of speaking and a quizzical gaze and totes several pens, a leatherbound notebook and an index card in the breast pocket of his shirt. He’s also an obsessive jogger, who sometimes runs from the office to his home in Friendship Heights on the northwest edge of the District of Columbia.

It’s an empiricism that extends to life around his spacious new office. The budget director spoke to Politico on the side of his office he refers to as “the living room.” In it, a small red sofa and two hard wooden armchairs face a marble fireplace. When Orszag arrived for his first weekend of work on a snowy January day, there were logs neatly stacked.

“It still seemed a little suspicious. So I lit a piece of paper to see if it vented,” Orszag said. The smoke went up the chimney.

“So then we lit a few logs. It was venting. It was fine,” he said. The only problem: The Secret Service had capped the building’s chimneys. Smoke alarms started going off upstairs, and the building was evacuated.

And though Orzag wasn’t publicly named as the culprit (“Smoke Linked to Attempt to Use 2nd-Floor Fireplace,” was the Washington Post’s headline the next day.), the incident remains the source of much amusement inside the White House.